Dealing with Cushings in a third world country

[M&Inu]

Hi Lori and Leslie,

Thank you so much for your answers. I want to answer more tomorrow. But right now I am having one of my crisis of so much fear.

I have noticed Inu more and more “lethargic”, she sleeps so deeply and only needing to go to the bathroom and food rouses her. I am now fearful she is in the end stages of the disease and all is too late.

I hope I am overreacting, but still I would like to know from you all that have more experience, if this is it? Is the disease too advanced and the crotisol has already done too much, irreparable, damage?

I am sorry not to answer to your important information, I will do it tomorrow when I am in a better state of mind. I just am having an attack of fear and am so worried right now that I have waited too long, listened to the wrong doctors (here in my country) and that we are already in end stages.

Thank you for listening to me.

[Harley PoMMom]

Cushing's is a very slow progressing disease and it can take years for a dog to succumb to the long term effects of high cortisol on their internal organs and immune system. In your initial post you mentioned that Inu's liver enzyme values were within the normal limits, which is a positive sign, because 80-90% of cushdogs generally do have high elevations in the Alkaline Phosphatase (ALP) which is one of the liver enzymes.

The dose for the SDG that Leslie posted is the correct one but since you are giving Inu the HMR type the active ingredient of HMR lignan is different from that of SDG flax hull lignan. The recommended HMR dose is 10-40 mg/day for small to large dogs, and as Leslie stated you need to look for the standardized percentage of HMR on the label. With the melatonin you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. I apologize for all this information that I am throwing at you and I hope it's not too overwhelming or confusing, and if it is please, please let us know, ok? Sending tons of soothing and loving hugs your way.

Lori

[Squirt's Mom]

ah....thanks for that, Lori. I didn't calculate the HRM indeed but rather the SDG.

As for Inu's behavior....there are no clear "end stage" signs for Cushing's. There are many things to consider - time of year, ie is the pup able to go outside in the sunshine as much as before, is it colder/hotter, etc.; are there other health issues in play that may be causing Inu to feel poorly; age related changes; has she started any of the supplements you listed and do any of them cause what you are seeing while the pup adjusts. One thing to consider is that as a pup ages they start to lose their senses - smell, sight, hearing - and those can cause a bit of withdrawal as the normal stimulants that surround them fade away. I have a Pug who is around 12 and over the last few months I often have to wake her for meals...and that is NOT a Pug characteristic! They are furry food vacuums naturally! She is slowing down and not as interactive as she once was but I am sure it is due to the aging process. She does have some health issues as well, like a seizure disorder, but Cushing's is not one of them. When we have a cush pup we tend to get tunnel vision and credit Cushing's for any and every change we see so keep in mind there could be many other reasons for how Inu is behaving.

You do want to listen to her, tho. You know her best of all and I believe our babies will tell us when they have had enough. But try to relax and consider all that could be in play and see her clearly, not thru the lens' of Cushing's fears - HARD to do at times, I know well. But I also know you are incredibly strong - you have proven that right off the bat with your first post here and by how hard you are fighting to get things to help your baby girl and learn all you can. Inu is very lucky to have you as her mom.

Hugs,
Leslie

PS. My offer of a shipping address still stands, just let me know if I can help with the Anipryl or anything else.

[M&Inu]

Hi all!

Really, so many thanks for your support. I think you are helping Inu a lot, since I know, me getting this anxious is not good for her, but I just have so many fears and doubts, and nobody to talk about it here. So I bottle it up, and up, and then I explode in a stress pure post like last night. And I am ashamed to say that so much is anger, I read of successful treatments with Lisodren and Trilostane, with the adequate testing and knowledgeable veterinarians, and I have to confess to feel envy. Because Anipryl really has such a low or non-existent success rate… Then I feel so ashamed of being envious of other people’s troubles…and it’s a vicious cycle. I just would love to be able to give her confidently Trilostane (or Lisodren, since some threads here tell me it’s incredibly successful also), because I think she would feel so much better, so much faster, but I can’t and it’s so frustrating. All these contradictory feelings and you all have to suffer my incoherent panic-babbling. Sorry.

I will begin to answer, finally:

I think your plan sounds excellent. Melatonin and lignans are the treatment for "Atypical Cushing's," this is when one or more of the adrenal hormones are elevated but the cortisol is not. The late and great Dr. Jack Oliver at University of Tennessee at Knoxville (UTK) was a premier scientific authority on the subject of Atypical Cushing's and according to a research paper written by Dr. Oliver titled: "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS"
The UTK lab does perform adrenal steroid profile testing and the treatment option sheet that is sent out with the test results does list melatonin and lignans as medical therapies (along with Trilostane and Lysodren). From that sheet:
Although the recommended treatment for atypical cushing's at UTK is very controversial among the veterinarian field I truly feel that trying this with Inu is really a great option. I've had quite a few email discussions with Dr Oliver in the past and he did state that it does take at least 4-6 months to see if any improvement will happen so you may want to give Inu the melatonin and lignans longer than 3 months.
I'm including a link to our Resourse Forum where you will find the information I quoted above, plus more regarding Atypical Cushing's: http://www.k9cushings.com/forum/show...Hyperestrinism
Also included in that thread are links that state what melatonin and lignans are preferred.
You are doing an awesome job!!!
Hugs, Lori
PS ~ I have used Pill Pockets and they worked great, I also hid them capsules in cream cheese or peanut butter too.

Thank you, Lori, and maybe I misused the term “snake oil”, I used it, not because, I think this treatment is not valid, but because all the veterinarians here have an approach to anything not 100% pharmaceutical or surgery is “old wife’s tales”. I went through this in Inu’s childhood and youth, when she had a persistent food allergy, red skin, itching, and the vet of that time wanted to prescribe her steroids (and said, yeah that’s going to be for life). I refused the steroids and went online and researched everything on raw feeding. I changed her diet to raw and home-made cooking only, without rice (she is totally allergic to it, if she gets a bit of rice, because if she finds it she snarfes it down like there is no tomorrow, its 100% sure vomiting session). And I got rid of her itching and red skin, she got a nice coat all her life on that diet. But almost all vets have tried to get me to change her to their brand of kibble, because raw is dangerous.
Also, when she started to present “arthritis” which now I blame on Cushing (hind leg weakness and trembling in hindquarters) all vets prescribed her NSAIDS, Rymadyl and the likes. I was so scared of the side effects, and gave her an herbal desinflamatory, Zyflamend, It helped her a lot for about one year. I have discontinued it right now, because I feel I am giving her way too many pills (?). But then again, I don’t know how much that was helping, because when she was on it, her hind quarters did not tremble as much as now and she did not walk as bowlegged and stiff…
I really hope some of these things have an impact on her. I HAVE to believe it. Thank you for the links I have read them through.

I think your plan is great! Like Lori said the combination of melatonin and lignans can help a great deal, especially with the intermediate hormones which come into play with Cushing's. The PS is something I used with my Sweet Bebe and it did help her a lot especially with mental acuity as she got older.
On the lignans....you say
You need to look on the bottle and see the percentage or actual amount of SDG in each capsule. For the Lignans for Life Flaxseed Lignans each capsule contains only 25mg of SDG. SDG is the workhorse in lignans and what helps our cush babies. So while the capsule may contain 80mg of LIGNANS they only contain 25mg of SDG. So check out the back of the bottle under the Supplement Facts and find the amount or percentage of SDG and work from that to determine the dose Inu needs. According to UTK (University of Tennessee in Knoxville where the majority of the research on this has been done) the dose of SDG is - "SDG lignan; one milligram/lb B. Wt./day". So at 89lbs she will need 89mg of SDG (NOT lignans) per day. If the capsule contains 25mg of SDG then she will take 4 capsules a day (89 / 25 = 3.56 capsules, rounded up to 4). Since lignans can cause some digestive upset, I would start with 2 as you planned then go to 3 then up to the recommended dose of 4 capsules a day. I would give her at least a week on each dose to make sure her gut is adjusting well before increasing to an additional capsule.
FYI - this is the Lignans for Life product I am looking at on Amazon. What you have may be different but the math still applies - look for the amount or percentage of SDG and work from there for the dose she needs. Remember, it is the amount SDG not the amount of lignans that matter. https://www.amazon.com/Lignans-Life-.../dp/B007D681K0
Now that I have thoroughly confused you, I am signing off. But feel free to ask and we will work with you to try and get the answers needed.
Hugs,
Leslie

Hi Leslie, thank you so much for all the information. You did not confuse me, I appreciate every guidance. I ordered SDG Lignans and HMR Lignans, since I wasn’t sure what would be best, and if there was a side effect or intolerance (or too much fiber in the SDG) that I could switch, without having to wait for a new order (also one large packets are sometimes better in the shipping costs, than many small ones, and I need to save every penny).
The SDG Lignan 35mg (90 capsules) I ordered states on the label: 1 capsule contains 230mg of Flaxseed Hulls and 35mg of SDG Lignans
The HMR Lignan 40mg (90 capsules) I ordered states on the label: 1 capsule contains 40mg HMR Lignans
The franklin vet told me HMR, and that what I was planning on starting with, a daily dose of 1 capsule = 40mg of HMR Lignan. If for some reason I need to, I can switch to the SDG Lignan in a higher dose.
So many thanks for the help with this.

Cushing's is a very slow progressing disease and it can take years for a dog to succumb to the long term effects of high cortisol on their internal organs and immune system. In your initial post you mentioned that Inu's liver enzyme values were within the normal limits, which is a positive sign, because 80-90% of cushdogs generally do have high elevations in the Alkaline Phosphatase (ALP) which is one of the liver enzymes.
The dose for the SDG that Leslie posted is the correct one but since you are giving Inu the HMR type the active ingredient of HMR lignan is different from that of SDG flax hull lignan. The recommended HMR dose is 10-40 mg/day for small to large dogs, and as Leslie stated you need to look for the standardized percentage of HMR on the label. With the melatonin you want to make sure that the melatonin is the plain kind not the fast-acting or slow releasing type. I apologize for all this information that I am throwing at you and I hope it's not too overwhelming or confusing, and if it is please, please let us know, ok? Sending tons of soothing and loving hugs your way.
Lori

Hi Lori, her liver values are 157 U/I (the normal range is supposedly 74-104) I had a freak out when I saw her 53 U/I over “normal” and her vet (the local one) assured me that that is not a worrisome level….Still I have her on Denamarin now, and ordered the SAMe and Milk Thistle from Lignans for Life, because they have good ratings and are cheaper than Denamarin.
I am using Melatonin without any kind of extra addition from GNC, I already had that because my mother took it for a while, but ordered more in Lignans for Life.
This is not at all overwhelming or confusing, I need and want any information, thank you!
I appreciate and also return hugs! Thank you.

ah....thanks for that, Lori. I didn't calculate the HRM indeed but rather the SDG.
As for Inu's behavior....there are no clear "end stage" signs for Cushing's. There are many things to consider - time of year, ie is the pup able to go outside in the sunshine as much as before, is it colder/hotter, etc.; are there other health issues in play that may be causing Inu to feel poorly; age related changes; has she started any of the supplements you listed and do any of them cause what you are seeing while the pup adjusts. One thing to consider is that as a pup ages they start to lose their senses - smell, sight, hearing - and those can cause a bit of withdrawal as the normal stimulants that surround them fade away. I have a Pug who is around 12 and over the last few months I often have to wake her for meals...and that is NOT a Pug characteristic! They are furry food vacuums naturally! She is slowing down and not as interactive as she once was but I am sure it is due to the aging process. She does have some health issues as well, like a seizure disorder, but Cushing's is not one of them. When we have a cush pup we tend to get tunnel vision and credit Cushing's for any and every change we see so keep in mind there could be many other reasons for how Inu is behaving.
You do want to listen to her, tho. You know her best of all and I believe our babies will tell us when they have had enough. But try to relax and consider all that could be in play and see her clearly, not thru the lens' of Cushing's fears - HARD to do at times, I know well. But I also know you are incredibly strong - you have proven that right off the bat with your first post here and by how hard you are fighting to get things to help your baby girl and learn all you can. Inu is very lucky to have you as her mom.
Hugs,
Leslie
PS. My offer of a shipping address still stands, just let me know if I can help with the Anipryl or anything else.

Thank you, Leslie, it’s hard to differentiate, but I had to battle against so many veterinarians that told me that all this is “just normal ageing” that now I maybe on the opposite side. I am just a ball of anger against my local vets…
But you made me think about her possible underlying arthritis, what I described above, that I had not thought how it could be affecting her mobility that I have her without her anti-inflammatory medication, because of the fear of giving her too many, so diverse, medications: interactions and possible over-exertion of the liver.
But when I read your answer it got me thinking: She has Cushings and many other things that cortisol is masking, any of those can be acting up, and her hindleg weakness has gotten worse since I stopped Zyflamend….Now I just have to evaluate if I should start her up again.
I also have been reading up on other threads, I think you Leslie have mentioned Adequan. Maybe since its an injection, it doesn’t over-exert her digestive system as much? But I have read, that that is also an NSAID that is hard on the liver, and maybe not so good to use, specially with Cushings dogs? I don’t know anymore…
Could the twice daily dose of Melatonin 5mg for a total of 10mg, that I already started her on be an element of the "lethargy"?
I also would appreciate advice on when to give the Anipryl. I am giving her the Denamarin on empty stomach, approximately between 5-6 am, it’s between 1-2 hours before her breakfast.
Should I move Denamarin earlier, like 4 am? So the Anipryl is more “alone” when taken with breakfast?
Trilostane I read has to be given with a meal in the mornings, how is it with Anipryl?
I will let you know Leslie if I need your generous offer for the Anipryl shipping. I haven’t ordered it, because I spend all day yesterday and part of today, because the order was cancelled, as I told you, but the charge on my card was not… I finally resolved it, so my bank was aware they pharmacy cancelled my order…but so much extra stress…
I will try again in another online veterinary pharmacy on Monday. For now I could start her tomorrow already, because I got my hands on some human Selegiline (5mg tablets, so I would give her 8 tablets to start her on her 40mg daily).
Also, to prove me wrong, she was a bit more perked up today, so with your answers and her being a bit more awake and willing to go for her walk, I am a bit more stable tonight, thank you.
I uploaded some pictures of Inu in her childhood and youth and current pictures of her and the toll Cushings had on her from a presentation I made for the veterinarian in Franklin to see, if someone has interest to look at that.
Again so many thanks for reading all my babbling and fears. And for comforting me, you are getting us through each day, thank you!

[Harley PoMMom]

Some vets are now using an in-house IDEXX SNAP® Cortisol Test instead of sending the blood sample out to a lab, however the vet does have to purchase the required equipment needed which I image would be expensive. Just in case your vet may be interested, here's a link to the IDEXX web page: http://www.idexx.com.au/smallanimal/.../cortisol.html

Again so many thanks for reading all my babbling and fears.

Ahhh, no thanks needed, we surely understand how scary all of this is and I can't image how distressed I would be in your situation, I was a such mess when my boy was first diagnosed.

Just took a look at your album and Inu is such a beautiful girl!!

[M&Inu]

Hi Lori, thank you so much for answering and providing this link. I am forwarding it to colleagues that work in labs that analize human samples, maybe they know more about the viability of importing such tests to use on existing machines in existing labs? I would ask my current local vet, but I am frustrated, he hasn’t answered my questions, via email, or phone, I feel ignored, specially when his fees are not cheap...and there is no interest of follow up....I feel so lost here with the veterinarians...
So maybe I need to keep on visiting local vets until I hit jackpot, but each one wants to their own blood test and all and I really don’t want to put Inu through so much stress. But maybe I can ask around for a vet that already has the SNAPshot Dx® Analyser o SNAP® Reader BenefitsAccuracy and we only would need to shop for the cortisol kit.

Thank you for saying that of her. The October 2017 picture was already very visible she is suffering from Cushing, you know two vets told me, nah, thats just “normal”. Then the January 2018 is where her harness is already modified to support her hind legs, that was when finally the current vet said, yeah probably it’s Cushing but there is nothing we can do...

Again thank you! I hope you have a nice weekend!

[Squirt's Mom]

Never, ever apologize for venting. You may have noticed just under our name at the top of the page these words - "support, educate, encourage, remember". That is why we exist...and "support" is the first word, leading the way for the remainder of our purpose. And truthfully you do not have any thing to apologize for....some of us were a lot worse. When Squirt was first diagnosed I found several other groups before I found our family here and by the time I DID find this group of people, I was a total basket case, completely off my rocker! I was terrified, frustrated, angry, and filled with guilt....riding a wild roller coaster of emotions, above all fully believing my Sweet Bebe was dying right in front of my eyes and there was nothing I could do to help her. She was my world and I could not imagine life without her. I was so bad by the time we got here that one of the members, who later became one of my dearest friends, told me I made her think of a woman with her finger stuck in a light socket - hair standing on end! She kindly left out the parts about my bulging eyes and flying slobber. I came here the Queen of "incoherent panic-babbling"! I was such a wreck I simply could not understand anything that was being said to me or anything I read. But these kind and loving folk took my hands and held me together until I could start to breath again, think again, hope again....and then they began to teach me what I needed to know to help Squirt have the best life possible. And for 7 years after, we lived a good life in spite of her illness and difficulties. I named myself a "Twitcher" because of the state I was in when I arrived and have always welcomed my brother and sister Twitchers to club...So WELCOME! You are not alone in this "exclusive" club by any means.

Something to keep in mind with arthritis - cortisol acts as a natural anti-inflammatory and will help with inflammatory conditions like arthritis, allergies, and so on. When the cortisol is lowered in our cush pups those conditions come roaring to the forefront, getting worse while the cush signs get better. So very often we need to play a balancing game - do we let the cortisol run a bit high to help arthritis/allergies/etc or do we lower the cortisol and try to manage the inflammatory condition(s) as they worsen? Which signs/condition(s) make our baby's life more miserable and which improve the quality of their life? Do we deal with the extreme hunger in exchange for less arthritic pain and disability or do we help them return to a more normal relation with food and deal with the pain in another way? But never with NSAIDS as you have already learned.

The hind leg weakness is different from arthritis, tho. That weakness is due to the cortisol destroying the muscle mass. This is also the cause of the pot-belly we see so often in our babies - the abdominal muscles simply lose strength. BOTH can certainly be in play - arthritis and loss of muscle mass...which brings us back to which do we choose to focus on, which causes our baby the most discomfort and loss of quality of life. If the Zyflamend was helping the legs I think I would go back to it as long as there are no contraindications with any of the other supplements/herbs you are using.

As for Anipryl - yes, it does have a low rate of success in controlling cortisol for MOST pups. However, Squirt was on it for over 9 months and it helped her a great deal. For Anipryl to have any effect the pups MUST have the pituitary form of Cushing's and the pituitary tumor MUST be located in the pars intermedia portion of the pituitary gland. 85% of cush pups have the pituitary form and of that 85% only about 25% have the tumor in the right place for Anipryl to work. So that helps explain why the efficacy of this drug is so low. Apparently Squirt's tumor was locate in the pars intermedia for it to work so well on her. So to me Anipryl is always worth a try especially in a situation like yours where the traditional drugs are not available or they are cost prohibitive or the pup cannot handle the tradition treatments for some reason. Inu may be a bit restless at first on the Anipryl but that will improve as she takes the drug longer so don't panic if she seems to be hyper for a little bit when she first starts. It can also cause digestive upset so I would give it with food always and on its own. If you have access to Pepcid AC (NO other form of Pepcid can be used), Zantac, or Tagamet you can give one of these 20-30 minutes before the Anipryl to help with the tummy upsets if needed. The generics of these work just as well as name brand based on my experience. The generics are Famotidine, Cimetidine, and Ranitidine respectively. Scroll about half way down this page to find a chart for the doses used - http://www.walkervalleyvet.com/otc-meds.htm

And yes, you may have hit the nail on the head with the melatonin and lethargy. It may take a bit but that should improve as she adjusts.

We have seen liver values in the 1000's when the high normal is 300 or less. So Inu's liver value is not excessive compared to many we see...another reason you can take a deep breath and put that worry on a back burner. I would continue the home-cooking and raw feeding as long as the fat content is not high. Our cush pups are prone to pancreatitis and we can help fend that off by keeping their diets low in fats.

All in all, you are doing a wonderful job, Mom. So give yourself a big pat on the back and do something for you, just for you for a minute. Something that brings YOU pleasure deep in your Soul....you deserve a minute or three for all the hard work you have done so far.

Hugs,
Leslie

[molly muffin]

Hello, I just wanted to pop in again and say, what alovely girl Inu is. Love her pictures. Yes there is certainly the signs we general see with cushings showing in her pictures, thinning hair on tail, darker color stomach, muscle loss, but she still looks really good.

As leslie said, being 50, 60 points over is fairly low with what we generally see with cushing dogs so that is a very good thing. It does tend to go, so don't be overly alarmed.

I cannot even imagine the frustration you are going through not having the options that so many others have in regards to treatment and testing. I can tell you that it is frustrating even when you do have the options available trying to get dosage right. Not having it, must make the frustrations 100 times worse, so it's natural to have those crazy days of anger, sorrow, worry.

Melatonin can contribute to lethargy, and it might just be a matter of her adapting to it.

I think you are doing an excellent job advocating for Inu!

[M&Inu]

Hi Leslie, thank you so much for welcoming me into the “Twitcher” club, I really feel like that, but recently I have felt so tired all the time. I am not sleeping well and the stress has me tired all the time. I tried to give myself me time and going to a wedding, but that meant leaving Inu with my mother for one or two nights and I have been so paranoid and clingy. My mother would take excellent care of Inu, but I couldn’t imagine myself enjoying the time without thinking all the time about if Inu is getting up by herself, or if she needs help, if she too passive…IDK it was just too much and I said no. But I already made smaller plans, going out with friends, but just for coffee or lunch in the weekend. I have to start small.

The hind leg weakness has me worried and I am so scared that if I can’t get her cortisol down it will waste away her muscles... I was thinking, has someone done hydrotherapy with your Cushings pups? I was thinking of putting up an inflatable swimming pool about 10 feet in diameter and 2-3 feet in depth and putting her inside to wade a bit. I am worried about her weight (89 pounds) and she being so slow and without interest in moving that the muscle weakness is going to get worse.
Also, right now we are in our “cold season” this means LOW Temperature: 8 degrees Celsius (46 degrees Fahrenheit) and HIGH Temperature 20 degrees Celsius (68 degrees Fahrenheit). So Inu is finally sleeping for some small periods of time on her bed or on her blankets, but still mostly on the cold hard floor, because she is hot all the time. I am dreading the warm season again. Its soooo hard on her. The temperatures rise to 30 degrees Celsius (86 degrees Fahrenheit). Could the pool help for that at least?
Also I was thinking of a wheelchair, so she can walk a bit more again, with most of her weight being supported by the wheelchair? (https://www.k9carts.com/full-wheelchair)
I would be able to build something similar with a friend of mine. I just wanted to know if someone has used it, to help your dogs with the weakness and to rehabilitate the muscle.
We are on day five of Selegiline (human tablets I could get for her to start on, until the Anipryl comes*). I haven’t seen her hyper, I think she has been a little bit more alert, more interested in her environment, her nose is a bit colder and finally a bit more humid, her eyes maybe a bit less red and the polidypsia is maybe not as bad, but the hunger is still so bad, I even maybe feel it’s gotten worse, she wants to eat all the time (I don’t even know anymore what wishful/dreading (positive and negative) thinking is anymore). I feel incapable of objectively assessing if the medicine is having effect.
*The order finally was approved, the prescription was approved all was ready and now they have it on backorder, out of stock, and I have to wait, I don’t even know how long until its shipped…. honestly, I feel everything is a battle.
Again Leslie, so many thanks, really. I think I have to re-learn how to give myself space and time to just breathe. I feel like I have been a year or more (since I was seeing the symptoms all the vets were telling me its “just normal ageing”) I have been on alert and full stress.

Hi Sharlene, Thank you for looking at Inus pictures, I love to show her to everyone, even with her body having suffered under Cushings, she is still beautiful to me. But if I start to compare her pictures in the last two years and see all the signs that veterinarians refused to see I get so angry again. Thank you for your kind words.
With the liver values I so hope Denamarin, or SAMe and Milk Thistle, helps a bit out there. I swing from one extreme to another: wanting to have her blood tested again to see if in the last month-and-a-half something changed for the worse, and wanting to avoid the veterinarian clinic, and not giving her even more stress with so much blood taking.

Again, thank you all for your support. I don’t know with out all of you giving me hope and most importantly, understanding. Thank you!

[Harley PoMMom]

The hydrotherapy sounds like a great way to help with that muscle loss, I believe some members have tried cold laser therapy and acupuncture too. The wheelchair looks like it could help too and that's awesome that you could build it!!

My Harley's body temperature seemed to run hot too and I would spritz his feet with water to try to keep him cooler. Cush dogs do have an insatiable appetite and some members give their dog frozen green beans and carrots to help in satisfying that hunger.

Hugs, Lori